蚕蚀性角膜溃疡与细胞因子及组织移植技术治疗

Cytokines and tissue transplantation for Mooren's ulcer

学术背景:蚕蚀性角膜溃疡是一种病因不明的特发性免疫性疾病。由于该病的严重性及复发性,其治疗一直较为棘手。目前,随着新型有效的免疫抑制药物的应用,在疾病发展的不同阶段联合相应的组织移植技术治疗,取得了较好的疗效。目的:着重综合阐述目前蚕蚀性角膜溃疡应用细胞因子、免疫抑制剂以及组织移植技术的治疗。检索策略:应用计算机检索PUBMED1990-01/2007-05的相关文章,检索词为"mooren’s ulcer medicine surgicaltreatment",限定文章语言种类为English。同时计算机检索CNKI1990-01/2007-05的相关文章,检索词为"蚕蚀性角膜溃疡,药物,移植技术,治疗",限定文章语言种类为中文。纳入标准:①具有原创性,论点论据可靠的临床研究文章。②观点明确,分析全面的综述文章。排除标准:重复研究。文献评价:共收集到30篇符合纳入标准的文献,主要来源于RCT,循证医学系统综述,涉及蚕蚀性角膜溃疡的药物及手术等治疗方面。资料综合:①蚕蚀性角膜溃疡的药物治疗:生物因子及新型的免疫抑制剂对早期蚕蚀性角膜溃疡有较好的疗效,并期望能够使用有效的药物治疗从而减少手术所致的创伤。②蚕蚀性角膜溃疡的组织移植治疗:各种粘合剂及结膜切除并联合羊膜移植、板层及穿透性角膜移植在不同时期的溃疡阶段均取得较好的疗效。③经过大量的临床研究显示:使用药物联合手术的综合疗法对蚕蚀性角膜溃疡有确切的疗效。结论:各种生物因子及新型的免疫抑制剂对于早期蚕蚀性角膜溃疡的治疗起到很重要的作用,在溃疡的不同时期应用组织移植技术联合药物治疗是目前蚕蚀性角膜溃疡治疗的有效方法。

BACKGROUND： Mooren＇s ulcer is an agnogenic and specific immunological disease. It is always troublesome due to its severity and recurrence. At present, better curative effect has achieved by using new types of immunosuppressive drugs combined with corresponding tissue transplantation at different periods of the disease. OBJECTIVE： To summarize the treatment of Mooren＇s ulcer by cytokine, immunosuppressant and tissue transplantation currently. RETRIEVE STRATEGY： Pubmed was searched with computer for related English articles between January 1990 and May 2007 with the keywords of ＂mooren＇s ulcer medicine surgical treatment＂. Meanwhile, we searched CNKI for relevant Chinese articles dated between January 1990 and May 2007 with the keywords of ＂mooren＇s ulcer, medicine, transplantation, treatment＂ in Chinese. Those ①origin and reliable clinical research articles and ②well analyzed review articles with clear opinions were included. Repetitive studies were excluded. LITERATURE EVALUATION： A total of 30 literatures met the inclusive criteria were collected, mainly from RCT and systematic review articles on evidence-based-medicine involving the drug and surgical treatment of Mooren＇s ulcer. DATA SYNTHESIS： ①Medication for Mooren＇s ulcer： Biological factors and new immunosuppressant shows good effect on Mooren＇s ulcer in early period, and the reduction of the wound from surgery is expected. ②Tissue transplantation for Mooren＇s ulcer： Treatment such as various adhesive materials, conjunctiva excision combined with amniotic membrane grafting, layer or penetrative corneal transplantation has achieved fine effects on Mooren＇s ulcer in different periods.③ Plenty clinical studies have showed that drug treatment combined with surgical treatment in Mooren＇s ulcer gets a perfect curative effect. CONCLUSION： Various kinds of biological factors and new immunosuppressant play important roles in treating Mooren＇s ulcer in the early period. At present, tissue transplantation combined with drug treatment properly used in different stages of Mooren＇s ulcer can reach perfect curative effect.